Trachoma

Trachoma usually affects both eyes. Five stages are described in the World Health Organization grading system.

Rarely, corneal neovascularization regresses completely without treatment, and corneal transparency is restored. With treatment and healing, the conjunctiva becomes smooth and grayish white. In a population survey in the Nile Delta of Egypt, 6.5% of adults had trachoma; of those, 13% had visual impairment and 8% were blind.

Diagnosis of trachoma is usually clinical because testing is rarely available in endemic areas. Lymphoid follicles on the tarsal plate or along the corneal limbus, linear conjunctival scarring, and corneal pannus are considered diagnostic in the appropriate clinical setting.

C. trachomatis can be isolated in culture or identified by nucleic acid amplification tests (NAAT) and immunofluorescence techniques, and testing should be done when it is readily available. In resource limited-settings, testing may be limited to cases of diagnostic uncertainty. In the early stage, minute basophilic cytoplasmic inclusion bodies within conjunctival epithelial cells in Giemsa-stained conjunctival scrapings differentiate trachoma from nonchlamydial conjunctivitis. Inclusion bodies are also found in adult inclusion conjunctivitis Adult Inclusion Conjunctivitis Adult inclusion conjunctivitis is caused by sexually transmitted Chlamydia trachomatis. Symptoms include chronic unilateral hyperemia and mucopurulent discharge. Diagnosis is clinical... read more , but the setting and developing clinical picture distinguish it from trachoma. Palpebral vernal conjunctivitis appears similar to trachoma in its follicular hypertrophic stage, but symptoms are different, milky flat-topped papillae are present, and eosinophils (not basophilic inclusion bodies) are found in the scrapings.

The World Health Organization (WHO) recommends that individual or sporadic cases of trachomatous inflammation–follicular be treated topically. The WHO also recommends topical treatment for trachomatous inflammation–intense, but that systemic treatment should be considered. Trachomatous scarring alone does not require treatment until it progresses to cause trachomatous trichiasis.

For systemic treatment, a single oral dose of azithromycin 20 mg/kg (maximum 1 g) is 78 to 95% effective. As an additional benefit, the use of oral azithromycin has been associated with a significant reduction in overall childhood mortality. Alternatives include erythromycin 500 mg twice daily for 14 days or doxycycline 100 mg twice a day for 10 days (not to be used in pregnant or breastfeeding women or in children under the age of 8). For topical treatment, tetracycline 1% ointment to both eyes twice a day for 6 weeks can be used.

The WHO recommends eyelid surgery for trachomatous trichiasis. If corneal opacity has advanced into the central cornea, it is considered the stage of untreatable irreversible blindness. In resource-rich nations a corneal transplant Corneal Transplantation Corneal transplantations are done for several reasons: To reconstruct the cornea (eg, replacing a perforated cornea) To relieve intractable pain (eg, severe foreign body sensation due to recurrent... read more could restore vision. The procedure is complex, and the frequent and intense aftercare to prevent rejection and infection makes corneal transplant impractical for many patients in most resource-limited nations.